Ciprofloxacin Compared to Placebo in Diagnosing Prostate Cancer in Patients Undergoing Prostate Biopsy

PRIMARY OBJECTIVES: I. To determine the non-inferiority of the rate of detection of prostate cancer in men with decreased serum PSA values treated with placebo compared to ciprofloxacin prior to prostate biopsy. SECONDARY OBJECTIVES: I. To compare the change in PSA from randomization to biopsy in men treated with ciprofloxacin versus those treated with placebo. II. To compare the rates of post-biopsy complications (including duration of hematuria, hematochezia, hematospermia, fever \> 101°F, and hospital admission rates related to biopsy, sepsis, and pain) between men treated with ciprofloxacin versus those treated with placebo. TERTIARY OBJECTIVES: I. To determine if benign prostatic hyperplasia (BPH) or erectile dysfunction are associated with abnormal PSA or prostatic inflammation reported in the biopsy specimen. II. To determine the correlation between change in PSA from randomization to biopsy and urinalysis pre- and post-ciprofloxacin versus placebo. III. To determine the correlation between change in PSA and prostate massage pre- and post-ciprofloxacin versus placebo. IV. To determine the qualitative and quantitative difference in flora (ciprofloxacin resistant organisms) obtained from rectal swab pre- and post- two week course of ciprofloxacin vs. placebo. V. To correlate prostate symptom severity (International Prostate Symptom Score \[IPSS\]) with erectile function (International Index of Erectile Function \[IIEF-5\]) at baseline. VI. To correlate urinary, prostate massage or rectal swab findings to pathology findings including cancer, inflammation, prostatic intra-epithelial neoplasia (PIN), atypical acinar proliferation (ASAP) or other findings at the end of the study. OUTLINE: Patients are randomized to 1 of 2 treatment arms. ARM I: Patients receive ciprofloxacin orally (PO) twice daily (BID) for 2 weeks. ARM II: Patients receive ciprofloxacin PO BID for 2 weeks.